Madhesh Hospitals in Crisis: Shortages of Medicine, Staff Gaps, and Idle Equipment

The Ministry of Health and Population of Madhesh province has spent only 16% of its total budget of Rs. 6.45 billion for the current fiscal year as of March 8.

Although the ministry has spent 24% of its current expenditures, capital expenditure remains negligible at just 1.23%, highlighting weak performance in implementation.

The situation was no different in last fiscal year. Around 45% of the total budget remained unspent and was “frozen”. The inability to spent the budget in a sensitive sector like health, and weak implementation of project plans, raises serious questions about the provincial government’s priorities.

Government hospitals in a ‘sick’ condition

The provincial hospital in Jaleshwar, Mahottari appears sick itself. Upon entering the hospital premises, a foul odor is immediately noticeable. Garbage is piled up around, hospital wards are disorganized, and there isn’t even a clean place for patients or their attendants to sit.

Although the 15-bed Jaleshwar hospital has been upgraded to a 100-bed facility by the provincial government, patients are not receiving the expected services due to a shortage of staff and poor management.

Ramrati Chaudhary, who visited the hospital for knee pain treatment, said, “It’s dirty, but what can we do? If you come to a government hospital, you have to tolerate it. I’ve been waiting since morning after getting my slip, but neither has the doctor arrived nor does anyone seem to care.”

The hospital’s Medical Superintendent, Dr. Rabi Srivastava, said, “we are trying to organize the hospital, but staff management is the responsibility of the province.” Even the ambulance at the hospital is in a dilapidated condition.

At the hospital, where the patient numbers are high, accessing services is no easier. Hundreds of people stand in line just to get a registration slip. Even after that, patients often face the absence of doctors or a lack of medicines.

Although the positions for five specialist doctors (11th level) have been approved, only one is currently in place.

The Madhesh provincial government has placed this hospital under the Madhesh Institute of Health Sciences. “The government has not been able to provide sufficient budget or facilities even to run the institute properly. In such a situation, disorder is everywhere,” says the institute’s rector, Dr. Ram Naresh Pandit.

Equipment worth millions left unused

About 11 kilometers from the provincial capital Janakpur, Pipra Janata Hospital in Mahottari looks neat in exterior, but five rooms on the upper floor remain locked. Inside these rooms are the health equipment worth crores of rupees supplied by the provincial government.

In 2022, the Province Health Logistics Management Centre (PHLMC) sent equipment worth around Rs. 35.8 million to the hospital, including digital X-ray, ICU ventilators, patient monitors, anesthesia machines, ultrasound, OT tables, and other equipment.

However, this small hospital run by the rural municipality to provide basic health services, does not have human resource to operate these machines and facilities.

“These items arrived at some point, but I don’t know exactly when or how. I have just taken charge as the hospital chief,” says Santosh Yadav, hospital chief. “Right now, we don’t even have approval to run an operation theatre. We have requested permission from the ministry”, he added.

Yadav asserted that providing medicines to the local population would be far more useful. “The provincial government hasn’t supplied medicines. We have been managing with the limited medicines received from the municipality,” he adds.

A similar situation is seen at Jaleshwar hospital, where beds with ventilators, dialysis machines, and other equipment remain unused in locked rooms on the second floor.

Dr. Srivastava, Medical Superintendent, explains that a dialysis machine provided by the provincial government four years ago broke without being used. Other equipment are also covered in dust.

The PHLMC also provided equipment worth over 44.2 million to the Mother and Children hospital in Dhankaul, Sarlahi. But as the hospital itself has not been fully operational, the equipment is now becoming scrap.

The PHLMC’s procurement of equipment for Lahan hospital shows the purchases made without assessing actual need. According to the approved annual program of FY 2023/24, equipment worth 53.7 million was procured for the hospital. After the purchase, on June 5, 2024, the center wrote to the hospital asking whether the hospital had necessary staffs required to operate the equipment. Lahan hospital responded that due to lack of necessary staff, the equipment should only be supplied once staffing was in place. Eventually, the equipment was transferred to Janakpur hospital as they were unusable in Lahan.

From the FY 2022/23 budget, the center also purchased waste management equipment worth 41 million and bone densitometers worth 18 million for the provincial hospitals in Sarlahi and Rautahat, but these have also not been put into operation.

“Even we cannot give exact details of how these purchases were made, and we assure that it is not appropriate to buy equipment without actual need,” says Dr. Pramod Kumar Yadav, health secretary of Madhesh province.

No medicine purchases for two years

Province government of Madhesh has not purchased medicines for provincial hospitals in the past two years.

In the previous fiscal year, three tenders were announced for medicine procurement, but due to changes in directors and various disputes, the process was canceled, and no purchase could be made.

Dr. Rajiv Jha, Director of the PHLMC, said that the roughly 160 million budgets allocated for medicine procurement remained frozen. “However, we have already initiated the procurement process this year,” he added.

Political interference has caused frequent changes in the PHLMC’s leadership. Last year, four directors were replaced. Dr. Manish Pandey, who joined as director on December 6, 2023, was transferred on October 6, 2024. His successor, Dr. Rajiv Kumar Jha, was transferred again just four months after taking charge, on March 15, 2025

Dr. Jha had called for tenders for medicine procurement, but the ministry canceled them, claiming the tenders were issued to benefit certain individuals, contrary to the procurement act and health directives.

Following this dispute, Dr. Sunil Prasad Kushwaha was appointed director. However, within a few months, Dr. Jha returned to the position once again.

Problems persist without an updated ONM survey

Apart from Janakpur, Madhesh has six provincial hospitals in Jaleshwar, Siraha, Lahan, Malangwa, Gaur, and Kalaiya. Although these hospitals have been “upgraded” to 100- and 150-bed facilities, the allocated positions for permanent staffs remain at the old 15-bed level. Additional staff have been hired on contract, daily wages, or attendance-based arrangements to keep operations running.

This so-called “upgrade” of hospitals was done two years ago during the tenure of then health and population minister Birendra Prasad Singh.

For the past three years, the provincial government has not even opened vacancies or new positions on health services. The Organization and Management (ONM) survey determines the need of the staffs and since it has not been updated, the process for determining sanctioned posts and filling permanent positions has not progressed.

According to Health Secretary Dr. Pramod Kumar Yadav, preparations for updating the ONM are underway this year. “Due to various reasons, the ONM could not be conducted earlier. But now, we have made it a priority to ensure proper management of hospitals under the provincial government,” he said.

Provincial hospitals, other hospitals, and public health laboratories under Madhesh province government are unable to provide effective services due to extreme staff shortages.

Medicine shortages, staff crises, procurement of equipment without proper infrastructures, weaker budget spending, and administrative instability have pushed the health system of Madhesh province into a serious crisis.

With hospital upgrades remaining only on paper, patients are unable to access proper treatment. Transparent procurement processes, permanent staff management, and effective plan implementation are urgently needed to improve health services.

Published in Annapurna Post on 10 March 2026